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Eur J Heart Fail. 2017 Apr;19(4):579-587. doi: 10.1002/ejhf.790.

Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial.

Author information

1
Women's College Hospital, Toronto, ON, Canada.
2
University Health Network/Mount Sinai Hospital, Toronto, ON, Canada.
3
University of Ottawa Heart Institute, Ottawa, ON, Canada.
4
Hospital Universitario Txagorritxu, Vitoria, Spain.
5
Queen's University, Kingston, ON, Canada.
6
Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
7
McGill University Health Centre, Montreal, QC, Canada.
8
St Michael's Hospital, Toronto, ON, Canada.
9
Instituto do Coração do Hospital das Clínicas da FMUSP, Sao Paulo, Brazil.
10
Hôpital Hôtel-Dieu du CHUM, Université de Montréal, Montreal, QC, Canada.
11
Capital District Health Authority, Halifax, NS, Canada.
12
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada.
13
Universitätsklinikum Regensburg, Regensburg, Germany.
14
University of Arizona College of Medicine, Tucson, AZ, USA.
15
Groupe Hospitalier Pitie-Salpetriere Charles Fox, Paris, France.
16
Juntendo University Hospital, Tokyo, Japan.
17
Ospedale San Luca, Milan, Italy.

Abstract

INTRODUCTION:

Both types of sleep-disordered breathing (SDB), obstructive and central sleep apnoea (OSA and CSA, respectively), are common in patients with heart failure and reduced ejection fraction (HFrEF). In such patients, SDB is associated with increased cardiovascular morbidity and mortality but it remains uncertain whether treating SDB by adaptive servo-ventilation (ASV) in such patients reduces morbidity and mortality.

AIM:

ADVENT-HF is designed to assess the effects of treating SDB with ASV on morbidity and mortality in patients with HFrEF.

METHODS:

ADVENT-HF is a multicentre, multinational, randomized, parallel-group, open-label trial with blinded assessment of endpoints of standard medical therapy for HFrEF alone vs. with the addition of ASV in patients with HFrEF and SDB. Patients with a history of HFrEF undergo echocardiography and polysomnography. Those with a left ventricular ejection fraction ≤45% and SDB (apnoea-hypopnoea index ≥15) are eligible. SDB is stratified into OSA with ≥50% of events obstructive or CSA with >50% of events central. Those with OSA must not have excessive daytime sleepiness (Epworth score of ≤10). Patients are then randomized to receive or not receive ASV. The primary outcome is the composite of all-cause mortality, cardiovascular hospital admissions, new-onset atrial fibrillation requiring anti-coagulation but not hospitalization, and delivery of an appropriate discharge from an implantable cardioverter-defibrillator not resulting in hospitalization during a maximum follow-up time of 5 years.

CONCLUSION:

The ADVENT-HF trial will help to determine whether treating SDB by ASV in patients with HFrEF improves morbidity and mortality.

KEYWORDS:

Adaptive servo-ventilation; Cardiovascular hospital admissions; Central sleep apnoea; Heart failure; Mortality; Obstructive sleep apnoea; Sleep-disordered breathing

PMID:
28371141
DOI:
10.1002/ejhf.790
[Indexed for MEDLINE]
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